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The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder

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 titanic1    244


Abstract-The authors present case histories indicating that a number ofpatients find cannabis (marihuana) useful in the treatment of their bipolardisorder. Some used it to treat mania, depression, or both. They stated thatit was more effective than conventional drugs, or helped relieve the sideeffects of those drugs. One woman found that cannabis curbed her manicrages; she and her husband have worked to make it legally available as amedicine. Others described the use of cannabis as a supplement to lithium(allowing reduced consumption) or for relief of lithium's side effects.Another case illustrates the fact that medical cannabis users are in dangerof arrest, especially when children are encouraged to inform on parents bysome drug prevention programs. An analogy is drawn between the status ofcannabis today and that of lithium in the early 1950s, when its effect onmania had been discovered but there were no controlled studies. In the caseof cannabis, the law has made such studies almost impossible, and the onlyavailable evidence is anecdotal. The potential for cannabis as a treatmentfor bipolar disorder unfortunately cannot be fully explored in the presentsocial circumstances.

[EDITOR'S NOTE: The following article is based in part on materials thatappear in the revised and expanded edition of the authors' book, Marihuana,The Forbidden Medicine, republished in 1997 by Yale University Press, NewHaven and London. While the interviews have previously appeared in print,they provide a reference point for the authors' discussion of cannabis'potential role in the treatment of bipolar disorder as it appears in thistheme issue. In their revised and expanded book, Grinspoon and Bakalardiscuss a wide range of what they refer to as "Common Medical Uses" and"Less Common Medical Uses" for cannabis. The former include treatment forthe nausea and vomiting of cancer chemotherapy, glaucoma, epilepsy, themuscle spasms of multiple sclerosis, paraplegia and quadriplegia, the weightloss syndrome of AIDS, chronic pain, migraine, rheumatic diseases, pruritus,PMS, menstrual cramps and labor pains, depression and other mood disorders.The latter include treatment for asthma, insomnia, antimicrobial effects,topical anesthetic effects, antitumoral effects, dystonias, adult ADD,schizophrenia, systemic sclerosis, Crohn's disease, diabetic gastroparesis,pseudotumor cerebri, tinnitus, violence, PTSD, phantom limb pain, alcoholismand other addictions, terminal illness and aging.]

In bipolar or manic-depressive disorder, major depression alternates withuncontrollable elation, or mania. Symptoms of depression include loss ofinterest and pleasure in life, sadness, irrational guilt, inability toconcentrate, appetite loss, lethargy, and chronic fatigue. Manic symptomsinclude sleeplessness, tirelessness (until exhaustion leads to a breakdown),and recklessly gregarious and expansive behavior, which sometimes turns toirritability, rage and paranoid delusions. Bipolar disorder is treatedmainly with lithium salts and anticonvulsant drugs, which can have seriousside effects. Thirty percent to 40% of patients with bipolar disorder arenot consistently helped by or cannot tolerate standard medications. In thecourse of the authors' studies of the medical uses of cannabis (Grinspoon &Bakalar 1997), a number of sufferers were discovered who believed marihuanato be more effective than conventional anti-manic drugs, or who used it torelieve the side effects of lithium.


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